Breast Cancer Symptoms: Examination, Stages, Treatment
Breast cancer is the second most common cancer in women, and is found in one in eight women in the United States. It is a group of diseases in which cells in the tissues of the breast become abnormal and divides without order or control. These malignant cells form too much tissue and become a tumor. The tumor can grow into nearby tissue or cells break away and enter the bloodstream or lymphatic system eventually affecting other organs. (University of Cincinnati, The Ohio State of University.)
Breast cancer is a malignant tumor that starts from cells of the breast. A malignant tumor is a group of cancer cells that may grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. The disease occurs almost entirely in women, but men can get it, too.(American Cancer Society)
Types of Breast Cancer
1. Ductal Carcinoma
* Hormonal therapy for women with hormone-receptor-positive DCIS
* Lobular Carcinoma:
2. Lobular Carcinoma
In the past, women with LCIS sometimes were advised to have a mastectomy. Current practice considers this unnecessary, because most women with LCIS will never develop breast cancer. A lumpectomy will be sufficient in most cases. Women who have been diagnosed with LCIS are often advised by their doctors to have regular mammograms (once every year or two), and also have clinical breast examinations performed by a physician once or twice a year.
3. Invasive Breast Cancer
Invasive, or infiltrating, breast cancer has the potential to spread out of the original tumor site and invade other parts of your breast and body. There are several types and subtypes of invasive breast cancer.
4. Inflammatory Breast Cancer
Signs and Symptoms
* Sudden increase in breast size (as much as a cup size in a few days)
* Change in breast skin color: pink, red, or dark-colored areas
* Skin looks like an orange peel (called peau d’orange)
* Constantly itching breast skin
* Breast is warmer, harder or firmer than usual
* Breast pain not related to menstrual cycle
* Nipple retraction – pulling inward
* Swollen lymph nodes under arm or above collarbone
* Chemotherapy to kill cancer cells and shrink tumors
* Radiation to your chest wall
* Targeted biological therapy
* Mastectomy to remove any residual cancer
* Axillary lymph node dissection
* Hormonal therapy to reduce your risk of recurrence
Classification of Breast Cancer
Grading is based on the microscopic structure of the tumor, according to the visual appearance of the cells. The pathologist is interested in how the cell compares to normal cells. Normal cells are well differentiated and are usually less aggressive. The pathologist also investigates how many cells are dividing and how actively they are dividing. The most aggressive cancers tend to have a lot of cells dividing at the same time, because they are growing very rapidly. Less aggressive tumors tend to have very few dividing cells. The pathologist also looks to see if there is cancer at the margin of the tissue that has been removed. If there are cancer cells only in the middle, there is a clean margin. Pathologists usually grade on a scale of 1-3, with the higher number being the most aggressive in appearance. When cells become differentiated, they take different shapes and forms to function as part of an organ. Cancerous cells lose that differentiation. In cancer grading, tumor cells are generally classified as well differentiated (low grade), moderately differentiated (intermediate grade), and poorly differentiated (high grade). Poorly differentiated cancers have a worse prognosis.
Staging is based on measurement of the tumor, lymph node involvement, and the metastatic spread (TNM).
The cells look like cancer but have NOT spread outside the breast ducts. It is very early breast cancer. This noninvasive breast cancer is called DCIS (Ductal Carcinoma in Situ). It puts the woman at a higher risk of developing invasive breast cancer.
The tumor is smaller than or equal to 2 cm (approximately one inch). It is invasive beyond the duct wall into the breast tissue, but has not spread outside the breast to the lymph nodes of the armpit. This is also described as early breast cancer.
When cancer is identified in the lymph nodes, it is categorized as Stage II. It is also stage II when the tumor is larger than 2 cm. but smaller than or equal to 5 cm, or independent of size, it has spread to one to three of the lymph nodes.
In general, tumors larger than 5 cm (two inches) or tumors with involvement in four or more lymph nodes are characterized as Stage III. When cancer has spread to the chest wall, including the ribs and certain muscles of the chest, it is called Stage III. Inflammatory breast cancer is Stage IIIB. In this rare type of cancer, the skin of the breast is red and swollen, or edematous.
Regardless of the size of the tumor, cancer has spread beyond the breast to the liver, lungs, brain, or any distant site other than the axillary lymph nodes.
3. Hormonal Response
A DNA microarray is a multiplex technology used in molecular biology. It consists of an arrayed series of thousands of microscopic spots of DNA oligonucleotides, called features, each containing picomoles (10−12 moles) of a specific DNA sequence, known as probes (or reporters). These can be a short section of a gene or other DNA element that are used to hybridize a cDNA or cRNA sample (called target) under high-stringency conditions. Probe-target hybridization is usually detected and quantified by detection of fluorophore-, silver-, or chemiluminescence-labeled targets to determine relative abundance of nucleic acid sequences in the target. Since an array can contain tens of thousands of probes, a microarray experiment can accomplish many genetic tests in parallel. Therefore arrays have dramatically accelerated many types of investigation.
4. Expressions of Proteins and Genes
Cells have receptors on their surface and in their cytoplasm and nucleus. Chemical messengers such as hormones bind to receptors, and this causes changes in the cell. Breast cancer cells may or may not have three important receptors: estrogen receptor (ER), progesterone receptor (PR), and HER2/neu. Cells with none of these receptors are called basal-like or triple negative. ER+ cancer cells depend on estrogen for their growth, so they can be treated with drugs to block estrogen effects (e.g. tamoxifen), and generally have a better prognosis.
Signs and symptoms of Breast Cancer
The first noticeable symptom of breast cancer is typically a lump that feels different from the rest of the breast tissue. More than 80% of breast cancer cases are discovered when the woman feels a lump. The earliest breast cancers are detected by a mammogram. Lumps found in lymph nodes located in the armpits can also indicate breast cancer.
Indications of breast cancer other than a lump may include changes in breast size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge. Pain (“mastodynia”) is an unreliable tool in determining the presence or absence of breast cancer, but may be indicative of other breast health issues.
Inflammatory breast cancer is a special type of breast cancer which can pose a substantial diagnostic challenge. Symptoms may resemble a breast inflammation and may include pain, swelling, nipple inversion, warmth and redness throughout the breast, as well as an orange-peel texture to the skin referred to as peau d’orange.
Another reported symptom complex of breast cancer is Paget’s disease of the breast. This syndrome presents as eczematoid skin changes such as redness and mild flaking of the nipple skin. As Paget’s advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain. There may also be discharge from the nipple. Approximately half of women diagnosed with Paget’s also have a lump in the breast.
In rare cases, what initially appears as a fibroadenoma (hard movable lump) could in fact be a phyllodes tumor. Phyllodes tumors are formed within the stroma (connective tissue) of the breast and contain glandular as well as stromal tissue. Phyllodes tumors are not staged in the usual sense; they are classified on the basis of their appearance under the microscope as benign, borderline, or malignant.
Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Metastatic breast cancer will cause symptoms that depend on the location of metastasis. Common sites of metastasis include bone, liver, lung and brain. Unexplained weight loss can occasionally herald an occult breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are “non-specific”, meaning they can also be manifestations of many other illnesses.
Most symptoms of breast disorder do not turn out to represent underlying breast cancer. Benign breast diseases such as mastitis and fibroadenoma of the breast are more common causes of breast disorder symptoms. The appearance of a new symptom should be taken seriously by both patients and their doctors, because of the possibility of an underlying breast cancer at almost any age.
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